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The rising elderly population and the concomitant increase in alcohol consumption can result in a ground level fall (GLF). The purpose of this study is to evaluate the in-hospital mortality, hospital length of stay, and discharge disposition of elderly patients who sustained a ground level fall (GLF) and tested positive for an elevated blood alcohol concentration (BAC). The data of patients who were 65 years and older, had an injury after a GLF, and tested for BAC were accessed from the American College of Surgeon – Trauma Quality Improvement Program (ACS-TQIP) from the calendar years of 2011–2016. Patients' demography, injury, comorbidities, and outcomes were compared between the groups who tested positive (>0.08 g/dL) and negative (0 mg/dL) for BAC. Univariate, followed by matched analyses were performed. All p values are two-sided, and a p value < 0.05 is considered statistically significant. Out of 20,163 patients who satisfied the inclusion criteria, 2398 patients (∼12%) tested positive for an elevated BAC. There were significant differences found between the two groups, BAC-positive vs. BAC-negative, in univariate analysis for age and sex with p values < 0.001. Propensity score matching balanced demographic characteristics; however, differences remained in certain comorbidities. Exact matching balanced patient demography, injury, and comorbidities. The paired-matched analysis showed no significant differences between the two groups for in-hospital mortality (2.1% vs. 2.1%, p = 1) and median hospital length of stay (5[4–5] vs. 5[5–5], p = 0.307). A higher proportion of patients in the BAC group suffered from alcohol withdrawal syndrome (AWS) and deep vein thrombosis (DVT) complications (9.5% vs. 1.4%, p < 0.001 and 1.5% vs. 0.5%, p = 0.018) compared to BAC-negative patients. A slightly higher percentage of patients in the BAC-positive group were discharged home without any additional services (39.6% vs. 36.9%, p = 0.009). Of the elderly patients who sustained a GLF and tested for BAC, approximately 12% tested positive for BAC. The overall in-hospital mortality was 2.1%. The BAC-positive group suffered from higher complications of AWS and DVT, and more than 60% of patients required additional services at the time of discharge. • Of all elderly patients who had fallen from a ground level height and were tested for BAC, 12% of them tested positive. • Approximately 2% died and 43% of the patients were discharged to a skilled nursing facility. • Patients who tested positive for elevated BAC had significantly higher incidence of alcohol withdrawal syndrome and deep vein thrombosis complications. • Implementation of preventive measures can reduce mortality, morbidity, and the health care costs associated with an alcohol-related fall. [ABSTRACT FROM AUTHOR]

Discharge against medical advice (AMA) leads to worse patient outcomes, increased readmission rates, and higher cost. However, AMA discharge has received limited study, particularly in pediatric trauma patients. Our objective was to explore the risk factors associated with leaving AMA in pediatric trauma patients. We performed a retrospective analysis on pediatric trauma patients from 2017 to 2019 using the National Trauma Data Bank. We examined patient characteristics including age (<18 years), race, sex, Glasgow Coma Scale, trauma type, primary payment methods, and Abbreviated Injury Scale. Multiple Logistic Regression models were utilized to determine characteristics associated with leaving AMA. Of the 224,196 pediatric patients included in the study, 238 left AMA (0.1%). Our study showed black pediatric trauma patients were more likely to leave AMA compared to nonblack patients (OR 1.987, 95% CI 1.501 to 2.631). Patients with self-pay coverage were more likely to leave AMA than those with other insurance coverages (OR 1.759, 95% CI 1.183 to 2.614). Blunt trauma patients were more likely to leave AMA than those with penetrating trauma (OR 1.683, 95% CI 1.216 to 2.330). Every one-year increase in age led to 15% increase in odds of AMA discharge (OR 1.150, 95% CI 1.115 to 1.186). Pediatric patients with severe abdominal injuries were less likely to leave AMA compared to those with mild abdominal injuries (OR 0.271, 95% CI 0.111 to 0.657). Patients with severe lower extremity injury were less likely to leave AMA compared to those with mild lower extremity injuries (OR 0.258, 95% CI 0.127 to 0.522). Race, insurance, injury type, and age play a role in AMA discharge of pediatric trauma patients. Black pediatric trauma patients have ∼ double the AMA discharge rate of nonblack patients. AMA discharge remains relevant, and addressing racial and socioeconomic factors provide opportunities for future interventions in pediatric trauma care. Level of Evidence : III, retrospective study. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) has been associated with higher mortality and morbidity in trauma victims. There is a paucity of information regarding the outcomes of severe AKI (sAKI) in pediatric trauma patients. Therefore, the trauma quality improvement program database (TQIP) was used to assess that hypothesis sAKI will be associated with higher mortality among pediatric trauma patients. The TQIP database was accessed for the study. Patients aged <18 years old admitted to the hospital after sustaining injury were included in the study. Demographics, injury severity score (ISS) and Glasgow coma scale (GCS) score, other body regions injuries, and available comorbidities were included in the study. Propensity score matching analysis was performed to compare the two groups, sAKI vs. no sAKI on patients' characteristics and outcomes. All p values are two-sided. A p-value <0.05 is considered statistically significant. Out of 139,832 patients who qualified for the study, 106 (0.1%) patients suffered from sAKI. Pair-matched analysis showed no significant difference between the groups, sAKI, and no sAKI, regarding the in-hospital mortality (14.3% vs. 12.4%, P = 0.838). There was a prolonged hospital length of stay in the sAKI group when compared to the no sAKI group, (27 days [21–33] vs. 10 [9–14], P < 0.001). There was a higher incidence of deep vein thrombosis (DVT) (12.4% vs. 2.9%, P = 0.024) in the sAKI group as well. The sAKI patients stayed in the hospital approximately three times longer and had a 4-fold increase in the occurrence of DVT. No significant difference was found between the groups in in-hospital mortality. Retrospective cohort study. 4. [ABSTRACT FROM AUTHOR]

The purpose of the study was to evaluate the outcomes of pediatric ventilated patients who underwent early tracheostomy. Our hypothesis is early tracheostomy will be associated with less ventilator days, Intensive care (ICU) days and hospital days. The Trauma Quality Improvement Program (TQIP) database of the calendar year 2017 through 2019 was used for the study. All pediatric trauma patients ≤17 years who were admitted to the hospital and were placed on mechanical ventilation were included in the study. Other variables included patients' demography, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, types of procedure that were performed for hemorrhage control. Propensity score matching analysis was performed between the early (≤7 days) and late tracheostomy (>7 days) groups. The primary outcome of the study was total hospital length of stay. Other outcomes were ICU days, ventilator days. Propensity score matching created 643 pairs of patients. The median age (years [interquartile range]) of the patient was 14 [8–16]. Most patients suffered from severe injuries with a median ISS 29 [22–38] and GCS score was 3 [3–8]. There was no significant difference identified between the early and the late groups, in hospital stay (24 [23, 26] vs. 24 [23, 26], P = 0.5), ICU days (14 [9–22] vs. 16 [9–23], P = 0.073) and ventilator days (10 [6–17] vs. 11 [7–18], P = 0.068). The incidence of pneumonia between the groups was (8.7% vs. 9.2%, P = 0.347). Early tracheostomy failed to show any outcomes benefit in ventilated pediatric trauma patients. [ABSTRACT FROM AUTHOR]

Background: In-hospital delirium after hip hemi-arthroplasty results in a prolonged hospital course and an increase in morbidity and mortality. Early identification of high-risk patients and preventive strategies can reduce the occurrence of delirium. The purpose of the study is to identify the risk factors of delirium and create a scoring system for point of care physicians. The risk factors were created and validated in the study.Hypothesis: Certain factors are associated with in-hospital delirium after hip hemi-arthroplasty in geriatric patients.Methods: The National Surgical Quality Improvement Program (NSQIP) database from 2016 to 2019 was accessed for the study. The study included all geriatric patients, ages 65 years and older, who underwent hip hemi-arthroplasty following a hip fracture. A multivariable analysis was performed to identify the risk of delirium using all the available information including patient demography, timing of surgery, comorbidities, and infective complications. Eighty percent of the data were used to develop a risk model, and 20% of the data were used to validate the model. A Receiving Operating Characteristics (ROC) curve was created. The Area Under the Curve (AUC) was calculated with a 95% confidence interval (CI). A Delirium Risk in Geriatric Hip Hemi-Arthroplasty (DRIGHA) score was created.Results: Out of 13,174 patients who qualified for the study, 3924 (29.8%) patients developed in-hospital delirium. The risk model showed advanced age, male gender, prior history of delirium and dementia, certain comorbidities, and complications were associated with a higher incidence of in-hospital delirium. The AUC was 0.79 (95% CI, 0.78-0.80). The DRIGHA score predicted the risk of delirium from 8 to 99.4%.Conclusion: Certain demography characteristics, comorbidities and infective complications were associated with a higher risk of developing in-hospital delirium. A DRIGHA score can be calculated at the bedside through a web-based calculator. Preventive strategies in high-risk patients will reduce the incidence of delirium. [ABSTRACT FROM AUTHOR]

• This study examine determinants associated with the permanent transition to nursing home among home care recipients with dementia. We identified two potentially preventable risk factors associated with permanent transition to nursing homes: depression and incontinence. In addition, having hip fracture and higher number of hospitalizations necessitated the transition. • Decision to make permanent transition from homes in the community to nursing homes is often not a personal choice, but driven by other factors, such as cognitive impairment, severe functional disabilities, availability of informal caregivers, cost, etc. The burden of disease and human toll of dementia is not only affected the individual with dementia, their caregivers, but also the society as well. • We anticipate that this study will refocus attention on the early diagnosis and treatment of depression and incontinence among older adults with dementia. Intervention strategies designed to prevent falls and hospitalizations may delay permanent transition to nursing homes. This retrospective cohort study uses the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS) to determine predictors associated with permanent transition to nursing homes among home care recipients with dementia. Study participants include older adults age 65+ with dementia who received home health services in New York State for at least 2 months prior to permanent transition to nursing homes. Multivariate logistic regression was used to quantify the association between predictors and permanent transition to nursing homes. Risk factors associated with permanent transition included increasing age (OR = 1.1; 95% CI 1.03-1.18); white compared to black (OR = 1.25; 95%CI 0.83-0.94), urinary and bowel incontinence vs. continence (OR = 1.46; 95% CI 1.37-1.56); depression vs. no depression (OR = 1.2; 95% CI 1.11-1.25); hip fracture vs. no hip fracture (OR = 2.63; 95% CI 2.27-3.05), and 3+ hospitalizations vs. no hospitalizations (OR = 3.02; 95% CI 2.77-3.29). Early diagnosis and treatment may delay or avert nursing home entry. [ABSTRACT FROM AUTHOR]

Background: Motorcyclists who drink and drive are at a higher risk of death and disability than other types of drivers. The purpose of this study was to query a national trauma database to evaluate the impact of elevated blood alcohol concentration (BAC) on outcomes in patients who sustained injury following a motorcycle crash.Methods: The National Trauma Data Bank (NTDB) data was accessed from 2012 to 2014. Patients ≥ 18 years of age who sustained a traumatic injury following a motorcycle accident with a confirmed blood alcohol test at the time of arrival to the hospital were included. Other variables examined were: sex, race, injury severity score (ISS), and initial Glasgow Coma Scale motor score (GCSMOT), systolic blood pressure (SBP, mm Hg), SBP <90, and comorbidities. Patients with a blood alcohol concentration (BAC) at or beyond the legal limit (0.08 g/dL) comprised the "alcohol positive" group, while those with a BAC confirmed negative comprised the "alcohol negative" group. The patients who tested BAC < 0.08 g/dl were excluded from the analysis. The primary outcome of the study was in-hospital mortality. Univariate followed by propensity matched analysis was performed. All p-values were 2 sided and p-values < 0.05 were considered statistically significant.Results: Of 113,843 patients involved in motorcycle crash, 67,183 patients underwent BAC testing. The majority (68.52%) tested negative, 21.14% tested positive above the legal limit and remaining 10.34% tested with a BAC <0.08 g/dl . A total of 29,922 patients, satisfied the inclusion criteria for final analysis. After propensity score matching, there was 100% improvement on standardized mean difference on matching variables (age, sex, race).However, differences continued between the groups on, SBP < 90, ISS and GCSMOT. The hospital mortality rates were 3.1% vs 3.9% (P < 0.001) between alcohol negative and the alcohol positive groups, respectively. The odds ratio of mortality in alcohol positive group was 1.27 (95% CI: 1.07, 1.53) and the absolute risk difference in hospital mortality was 0.008 (CI: 0.002, 0.014).Conclusion: Patients who tested with a BAC above the legal limit sustained a higher injury severity score and higher in-hospital mortality compared to patients who tested negative. [ABSTRACT FROM AUTHOR]

Early operative intervention, craniotomy, and/or craniectomy are occasionally warranted in severe traumatic brain injury (TBI). Persistent increased intracranial pressure or accumulation of intracranial hematoma postsurgery can result in higher mortality and morbidity. There is a gap in information regarding the outcome of repeat surgery (RS) in pediatric patients with severe TBI. An observational cohort study titled Approaches and Decisions in Acute Pediatric TBI Trial data was obtained from the Federal Interagency Traumatic Brain Injury Research Informatics System. All pediatric patients who underwent craniotomy or decompressive craniectomy, survived more than 44 hours and were found to have persistent elevated intracranial pressure >20 mmHg for 2 consecutive hours were included in the study. The purpose of the study was to find the outcomes of RS in pediatric severe TBI. Propensity based matching was used to find the outcomes. The primary outcome was 60-day mortality. Out of 1000 total patients enrolled in the Approaches and Decisions in Acute Pediatric Trial, 160 patients qualified for this study. Propensity score matching created 13 pairs of patients. There were no significant differences found between the groups who had RS versus those who did not have repeat surgery on baseline characteristics. There were no significant differences found between the groups regarding 60-day mortality, median hospital days, median intensive care unit days, and 6-month favorable outcome on Glasgow Outcome Scale Extended score. There was no difference in mortality between patients who underwent a second surgery and patients who did not have to undergo a second surgery. [ABSTRACT FROM AUTHOR]

Outcomes of trauma patients who tested positive for cannabis at the time of admission showed variable results. Sample size and research methodology that was used in prior studies may have resulted in the conflict. The purpose of the study was to evaluate the impact of cannabis use on outcomes in trauma patients using national data. Our hypothesis was that the use of cannabis will impact outcomes. The trauma quality improvement program (TQIP) Participant Use File (PUF) database of the calendar years 2017 and 2018 were accessed for the study. All trauma patients aged 12 years old and above who were tested for cannabis at the time of initial evaluation were included in the study. Variables included in the study were: race, sex, injury severity score (ISS), Glasgow Coma Scale (GCS) Score, Abbreviated Injury Scale (AIS) score of different body regions and comorbidities. Excluded from the study were all patients who were not tested for cannabis or tested for cannabis but were also tested positive for alcohol and other drugs and those suffering from mental conditions. Propensity matched analysis was performed. The outcome of interest was overall in-hospital mortality and complications. Propensity matched analysis created 28,028 pairs. The analysis showed no significant difference in-hospital mortality between cannabis positive and cannabis negative groups (3.2% vs. 3.2%). The median length of hospital stay in both groups was not significantly different (4 [IQR: 3–8] vs. 4 [IQR: 2–8] days). No significant difference was found between the two groups regarding hospital complications except in pulmonary embolism (PE) with 0.1% less incidence of PE in the cannabis positive group compared to the cannabis negative group (0.4 vs. 0.5%). The incidence of DVT was identical in both groups (0.9% vs. 0.9%). Cannabis was not associated with overall in-hospital mortality or morbidity. There was a slight decrease in the incidence of PE in the cannabis positive group. [ABSTRACT FROM AUTHOR]

The appropriate care of octogenarian trauma patients after a fall from ground level (FFGL) is a key factor for better outcomes. The purpose of this study is to use data from a national database to evaluate the outcomes of patients who are 80–89 years old with a history of anticoagulant use, sustained a FFGL, and were treated at a higher-level care institution. The Trauma Quality Improvement Program (TQIP) database of the calendar year 2017–2018 was accessed for the study. All hospitalized trauma patients between the ages of 80–89 years old with a history of anticoagulant use and sustaining an injury after FFGL were included in the study. Other variables included in the study are sex [male], race [white], initial systolic blood pressure (SBP mmHg), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hypotension with an SBP<110 mmHg and other comorbidities. The outcomes of the patients were compared with the care at higher-level trauma centers (Level I & Level II) and lower-level trauma centers (Level III) using propensity matched analysis. After propensity matching, 2348 patients were identified in each group. There was no clinically significant difference between the patients' characteristics who were treated at higher-level and lower-level care centers. A paired matched analysis showed greater mortality in patients who were treated at higher-level care centers compared to lower-level care centers (3.7% vs 2.6%, P = 0.03). The absolute difference in mortality was 1.1%[95% CI: 0.001, 0.022] which may not have any clinical relevance. A greater number of patients were discharged to home and a lesser number of patients were discharged to a skilled nursing facility (SNF) when they were treated at higher-level trauma centers. The care at higher-level trauma centers did not show any benefit in-hospital mortality in the short term. A higher number of patients was discharged to home without assistance. [ABSTRACT FROM AUTHOR]

Background Laparoscopic liver resection is growing in popularity, but the long-term outcome of patients undergoing laparoscopic liver resection for malignancy has not been established. This paper is a meta-analysis and compares the long-term survival of patients undergoing laparoscopic ( LHep) versus open ( OHep) liver resection for the treatment of malignant liver tumours. Methods A PubMed database search identified comparative human studies analysing LHep versus OHep for malignant tumours. Clinical and survival parameters were extracted. The search was last conducted on 18 March 2012. Results In total, 1002 patients in 15 studies were included (446 LHep and 556 OHep). A meta-analysis of overall survival showed no difference [1-year: odds ratio ( OR) 0.71, 95% confidence interval ( CI) 0.42 to 1.20, P = 0.202; 3-years: OR 0.76, 95% CI 0.56 to 1.03, P = 0.076; 5-years: OR 0.8, 95% CI 0.59 to 1.10, P = 0.173]. Subset analyses of hepatocellular carcinoma ( HCC) and colorectal metastases ( CRM) were performed. There was no difference in the 1-, 3-, and 5-year survival for HCC or in the 1-year survival for CRM, however, a survival advantage was found for CRM at 3 years ( LHep 80% versus OHep 67.4%, P = 0.036). Conclusions Laparoscopic surgery should be considered an acceptable alternative for the treatment of malignant liver tumours. [ABSTRACT FROM AUTHOR]

Background: Single nucleotide polymorphisms (SNPs) may function as modifiers of the RET proto-oncogene, resulting in the expression of medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC). We present 2 non-related Italian-American families (Family 1, n = 107; Family 2, n = 31) with the RET V804M mutation. We have correlated the presence of specific SNPs and the rare RET V804M mutation to MTC, C-cell hyperplasia (CCH), and PTC. Methods: Sequencing was performed on exons 10, 11, and 13-16 of the RET proto-oncogene. The presence of MTC, CCH, and PTC were correlated to specific SNPs. Results: In both families, 3 SNPs in exon 11 (G691S), exon 13 (L769L), and exon 15 (S904S) were detected in 100% of patients with overt MTC. The SNP L769L was present in all patients including patients with PTC, MTC, and CCH. Conclusion: SNP analysis revealed a similar pattern between the 2 families. SNPs in exon 11 (G691S) and exon 15 (S904S) appear to influence the development of MTC. A SNP in exon 13 (L769L) may serve as a modifier in the development of simultaneous MTC and PTC, as well as presentation of MTC, in patients with the RET V804M mutation. [ABSTRACT FROM AUTHOR]

Background: The rearranged during transfection (RET) V804M proto-oncogene mutation is rare and associated with medullary thyroid carcinoma (MTC). We present 40 members from a total cohort of 107 family members with this mutation. Methods: Family members were tested for RET mutations, calcitonin levels, and screened for pheochromocytoma and primary hyperparathyroidism (PHPT). Thyroidectomies were performed on 15 members. Surgery and pathology reports were obtained and reviewed. A pedigree was constructed. Results: A high penetrance was found for MTC and simultaneous papillary thyroid carcinoma (PTC; 40%). The incidence of PHPT was low (13%). There were no findings of pheochromocytoma. The course in the first family generation was indolent, with late onset of MTC. The second generation experienced earlier disease development; onset occurred earliest in the third generation. The second generation experienced a higher incidence of PTC than the first. Conclusion: This is the largest family with this mutation reported to date. However, it does not fit the classic familial MTC or MEN 2A cancer syndrome. Considering that PTC is not an incidental finding, but the result of an inherited RET V804 M mutation, we propose to identify this phenotypic expression as a unique syndrome consistent with manifestations of MTC, PHPT, and PTC. [Copyright &y& Elsevier]

Introduction: The development of acute kidney injury (AKI) in trauma patients has been associated with almost three fold increase in overall mortality. However, there is a paucity of information of early recognition of risk factors of severe AKI in trauma patients examining the patient's demography, injury characteristics and comorbidities. The purpose of the study was early identification of risk factors of severe AKI.Methods: This retrospective cohort study was performed using 2012-2016, American College of Surgeon Trauma Quality improvement program (ACS-TQIP) data, a national data base of trauma patients in the United State. All adult Trauma patients, age 16 to 89 years old, admitted to the hospital were included in the study. Other variables included; race, sex, initial systolic blood pressure (SBP), SBP<90 mmHg, heart rate, injury severity score (ISS), Glasgow Coma Scale Motor Score (GCSMOT), injury type and patient's comorbidities; diabetes mellitus (DM), hypertension (HTN), congestive heart failure (CHF) and history of smoking. A multiple logistic regression model was used to assess the chance of having severe AKI. The receiver-operating characteristics (ROC) curve was constructed, and the corresponding area-under-the curve (AUC) was calculated. All p values <0.05 was considered statistically significant.Results: Out of 935,402 trauma victims, 9,281 (0.99%) patients developed severe AKI. There were significant differences found between the groups (severe AKI presence vs AKI absence), regarding median age [IQR] (61[43-75] vs. 53[32-71]; p<0.001), ISS (18[10-29] vs. 12[9-17]; p<0.001), DM (25.6% vs. 13.2%; p<0.001), HTN (48.6% vs. 33.3%; p<0.001), CHF (9.8% vs. 3.4%; p<0.001) and history of smoking (16.5% vs. 21.3%; p<0.001) on univariate analysis. A multivariable analysis showed all variables above had a significant association of the development of severe AKI except history of smoking. Older age, male gender, high ISS, SBP<90 mmHg, history of DM, HTN, CHF had a higher odds of development of severe AKI. The model showed a moderate strength with area under the curve (AUC) value was 0.750 and the 95% confidence intervals were [0.740, 0.759].Conclusion: Current analysis showed certain patients demography, injury characteristics, along with comorbidities are associated with risk of severe AKI. [ABSTRACT FROM AUTHOR]

Background/aim To assess the impact of open versus laparoscopic surgery in cirrhotic patients undergoing a cholecystectomy using the Nationwide Inpatient Sample ( NIS). Methods All patients with cirrhosis who underwent a cholecystectomy (open or laparoscopic) between 2003 and 2006 were queried from the NIS. Associated complications including infection, transfusion, reoperation, liver failure and mortality were determined. Results A total of 3240 patients with cirrhosis underwent a cholecystectomy: 383 patients underwent an open cholecystectomy ( OC) whereas 2857 patients underwent a laparoscopic cholecystectomy ( LC), which included 412 patients converted ( LCC) from a LC to an OC. Post-operative infection was higher in OC as opposed to a laparoscopic cholecystectomy ( TLC) or LCC (3.5% versus 0.7% versus 0.2%, P < 0.0001). The need for a blood transfusion was significantly higher in the OC and LCC groups as compared with the TLC group (19.2% versus 14.4% versus 6.2%, P < 0.0001). Reoperation was more frequent after OC or LCC versus TLC (1.5% versus 2.5% versus 0.8%, P = 0.007). In-hospital mortality was higher after OC as compared with TLC and LCC (8.3% versus 1.3% versus 1.4%, P < 0.0001). Conclusion Patients with cirrhosis have increased in-hospital morbidity and mortality after an open as opposed to a laparoscopic or conversion to an open cholecystectomy. LC should be the preferred initial approach in cirrhotic patients. [ABSTRACT FROM AUTHOR]

Objective: To compare physiological and functional impairments and their impact on health care use patterns among disabled older women with and without hip fracture. Methods: Data from the 3-year longitudinal Women''s Health and Aging Study I (WHAS-I) and Medicare Current Beneficiaries Survey (MCBS) were used for this comparison study. Outcome variables include physiological measures (eg, hip and knee strength, functional reach), functional impairments (ADLs, IADLs), and health care use (physician visits). Generalized Estimation Equation (GEE) models were used to examine the differences between groups on physiological and functional change and health service use over time. Results: Three-year crude mortality rates were significantly higher in the hip fracture group (25%) than in the comparison group (18%); however, statistical significance did not persist after adjusting for age, race, education, living arrangement, depression, and comorbidity (RR = 1.5; P = .17). All physiological and functional measures deteriorated over time, regardless of presence or absence of hip fractures. After adjusting for covariates, the fracture group was significantly worse in knee strength (β = –0.91; P = .01), usual walking speed (β = –0.04; P = .01) and rapid walking speed (β = –0.05; P = .02), and worse IADL function (β = 0.26; P = .002) than the non–hip fracture group. The rate of additional impairment for both hip fracture group and non–hip fracture group was 0.013 IADL units per month (P = .001). However, there were no significant differences in health care use between the groups. Conclusion: In spite of worse physiological and IADL impairments, once the women recovered from hip fracture surgery, they did not necessarily use more health care resources than non–hip fracture patients. To prevent functional deterioration, interventions need to focus on knee strength and mobility training. [Copyright &y& Elsevier]

Summary Background Knowledge of nasal carriage is important in predicting staphylococcal infection, and no information exists regarding the endemicity of Staphylococcus aureus in Haiti. Methods We performed a cross-sectional analysis of S. aureus nasal screening in an acute care, a subacute rehabilitation, and a community setting, with a brief medical and epidemiological history. PCR-positive S. aureus screening nasal cultures underwent molecular analysis for spa type, SCC mec type, and virulence genes (Panton–Valentine leukocidin (PVL), toxic shock syndrome toxin (TSST), and arginine catabolic mobile element (ACME)), and were evaluated for antibiotic susceptibility using commercial tests. Results Overall carriage rates of 8.4% methicillin-susceptible S. aureus (MSSA) and 2.8% methicillin-resistant S. aureus (MRSA) were identified, with a high rate of tetracycline resistance. TSST and PVL genes were identified in MSSA. MRSA isolates contained no virulence markers. Unique MSSA phenotypes (i.e., linezolid-resistant, vancomycin-sensitive/daptomycin non-susceptible) were identified, as were two PVL-positive ST152 MSSA colonization isolates, previously geographically limited to Africa. Conclusions We found a low S. aureus carriage rate with complete vancomycin susceptibility and high tetracycline resistance, which has important public health implications with regard to treatment. Additionally, the finding of PVL-positive MSSA isolates, including the expansion of a previously described limited ‘divergent’ clone, ST152, warrants further evaluation. [ABSTRACT FROM AUTHOR]